Baseline Interview Guide

Interviews with Grantees Integrating Behavioral Health Treatment, Prevention, and HIV Medical Care Services

Documents and Forms

Document Name Document Type
Form Baseline Interview Baseline Interview Guide Form and Instruction
Baseline Interview Baseline Interview Guide MAI-COC Baseline Interview Guide_042816.docx Form and Instruction

Information Collection (IC) Details

IC Title:	Baseline Interview Guide	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	Baseline Interview Guide	Baseline Interview Guide	MAI-COC Baseline Interview Guide_042816.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 306	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	306	306
Annual IC Time Burden (Hours)	612	612
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.